Pathways of Addiction Opportunities in Drug Abuse Research (1996) / Chapter Skim
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7. Consequences
7. Consequences
Pages 159-191
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From page 159... ...
-- have devastating impacts on society and exact a cost of billions of dollars annually.1 Drug abuse is often the result of a constellation of factors including socioeconomic status, educational achievement, co-occurring psychiatric disorders, access to health care, employment status, and numerous other factors present in the lives of drug-abusing individuals (see Chapter 5)
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Other diseases and illnesses Injection drug users (IDUs) are more likely to develop serious infections and illnesses (e.g., viral hepatitis, endocarditis, pneumonia, other bacterial infec tions)
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. More than onethird of AIDS cases reported through December 1995 were related to injection of illicit drugs through three mechanisms: the sharing of contaminated injection equipment, heterosexual contact with an injection drug user (IDU)
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From page 162... ...
The injection equipment may or may not be rinsed, and if rinsed, may be rinsed with infected water.2 All drug users, injecting and noninjecting, place themselves at great risk for HIV transmission when engaging in unsafe sexual behavior while under the influence of drugs, such as alcohol and cocaine, or exchanging sex for money or drugs (Edlin et al., 1994; O'Connor et al., 1994)
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of the pediatric AIDS cases are associated with injection of illicit drugs -- 37 percent with maternal injection of drugs and 17 percent with maternal sexual contact with an IDU (CDC, 1995a)
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In New York City, HIV seroprevalence was found to be slightly more than 50 percent in a study of injection drug users (Des Jarlais et al., 1994)
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Prevention and Risk Reduction Strategies AIDS prevention intervention research is focused mainly on identifying and modifying behaviors known to be associated with HIV transmission; it targets individuals at high risk because of drug use and sexual contact. Education on hygienic injection practices and HIV transmission routes, condom distribution programs, and enrollment in drug abuse treatment are currently the major risk reduction interventions aimed at drug users in the United States.
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From page 166... ...
Specifically, epidemiological studies of the prevalence and correlates of HIV infection in vulnerable populations of drug users and IDUs; and studies of effective risk reduction strategies for changing sexual risk behaviors and drug injection behaviors are needed. IMPACTS ON FETAL, INFANT, AND CHILD DEVELOPMENT Drug abuse can have a significant impact on the health of children who either are exposed to nicotine, alcohol, or illicit drugs prenatally through maternal drug abuse or grow up in a drug-abusing household.
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From page 167... ...
As discussed in the previous section on AIDS, of the 6,948 cases of AIDS in children under 13 years of age reported to CDC through December 1995, 90 percent are attributable to perinatal HIV transmission and 54 percent of those cases are associated with injection of illicit drugs (CDC, 1995a)
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. Further, the majority of women who use heroin, marijuana, or crack cocaine also use varying amounts of alcohol and/or nicotine and may use one or more illicit drugs in combination.
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Prenatal Alcohol Exposure Alcohol in high doses is a potentially potent teratogen associated with a range of consequences, including congenital anomalies and neurodevelopmental impairments (reviewed in IOM, 1995)
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is caused by prenatal exposure to high levels of alcohol and is characterized by intrauterine growth retardation with concomitant poor growth in fetal weight and/or height; a pattern of specific minor physical anomalies that include a characteristic facial appearance; and central nervous system deficits including microcephaly, delayed development, hyperactivity, attention deficits, intellectual delays, and learning disabilities (Clarren and Smith, 1978; Smith, 1982)
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From page 171... ...
Prenatal Cocaine Exposure The effect of cocaine on fetal growth may be due to the norepinephrine- and serotonin-related effects of cocaine on vascular tone, which decreases uteroplacental blood flow and contributes to uteroplacental insufficiency (acute and chronic) , maternal hypertension, and fetal vasoconstriction (Moore et al., 1986; Woods et al., 1987)
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. In animal models of prenatal cocaine exposure, significant changes in monoaminergic activity are noted compared to controls (Dow-Edwards et al., 1988; Dow-Edwards, 1989; Seidler and Slotkin, 1992)
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and the timing of drug exposure affect fetal development in order to refine models of teratogenesis for specific drugs of abuse. Effects of Multiple Drug Use As already noted, most illicit drug abusers also abuse nicotine and alcohol and frequently abuse more than one illicit drug.
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Longitudinal Studies Ongoing longitudinal research across geographic and sociodemographic ranges should be promoted to identify the health and developmental problems and delays caused by prenatal drug exposure or a drugabusing environment. As suggested earlier, the possibility of drug-related effects appearing either later in development or under stressful conditions later in life requires carefully maintained longitudinal cohorts.
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From page 175... ...
Effects of Parental Drug Abuse When an infant is born, parental abuse of illicit drugs or alcohol may continue, often resulting in a chaotic life-style and an environment with increased incidence of child neglect, child abuse, and a lack of social interaction or responsive caregiving (Mayes, 1995)
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From page 176... ...
. A recent study of gun use found that it is predominantly sellers of illicit drugs, not users, who employ guns in their activities (Butterfield, 1995)
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Individuals initially use alcohol or illicit drugs because they produce some noticeable change in mood or emotional state; the extent and nature of that change varies depending on the specific drug or drug combination and the individual. However, it is difficult to determine a simple cause–effect relationship between the pharmacological actions of alcohol or illicit drugs and an individual's violent behavior because of the many interacting physiological, psychological, and social variables, each of which can have an impact on the drug–violence connection (NRC, 1993)
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, although the nature of any genetic influence on alcohol-related violence has not been studied. Additionally, other psychiatric disorders may impact on the aggressive actions of alcohol abusers (Miczek et al., 1994b)
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. Research is needed to determine the relationship between violence and the pharmacological effects of alcohol and illicit drugs in order to develop effective preventive interventions and treatment strategies, including research on patterns of alcohol and drug abuse involved in violent behavior and events in the early life history that are associated with violent behavior related to alcohol or drug abuse.
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Violence, Drug Abuse, and Co-Occurring Psychiatric Disorders There is evidence of a complex linkage among violence, drug abuse, and co-occurring psychiatric disorders. As discussed in Chapter 4, illicit drug and alcohol abuse are significantly more prevalent among persons who suffer from psychiatric disorders (e.g., schizophrenia, bipolar disorder, and depression)
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. Antisocial personality traits often underlie both drug abuse and violence, and those antisocial traits may co-occur with psychotic disorders or other major psychiatric disorders as well.
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1995. HIV infection and AIDS risk behaviors among injecting drug users entering methadone treatment: An update.
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1991. Immune Serum Markers and CD4 Counts in HIV Infected IV Drug Users.
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1994. Continuity and change within an HIV epidemic: Injecting drug users in New York City, 1984 through 1992.
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1992. Social intervention against AIDS among injecting drug users.
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1991. Maternal substance abuse and subsequent sudden infant death syndrome (SIDS)
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1994. Reducing HIV risk behavior among injection drug users: Effects of methadone maintenance treatment on number of sex partners.
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1994. Medical care for injection-drug users with human immunodeficiency virus infection.
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1994. Methadone treatment as a determinant of HIV risk reduction among injecting drug users: A nested case-control study.
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1992. High-risk sexual behaviors of intra venous drug users in- and out-of-treatment: Implications for the spread of HIV infec tion.
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American Journal of Obstetrics and Gyne cology 160:1107–1111. Zuckerman B, Frank DA, Hingson R, Amaro H, Levenson SM, Kayne H, Parker S, Vinci R, Aboagye K, Fried LE, Cabral H, Timperi R, Bauchner H
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